Increasing trend in enterococcal bacteraemia and vancomycin resistance in a tertiary care hospital in Croatia, 2017–2021

Todorić, Zrinka; Majdandžić, Ivana; Kregar, Tea Keretić; Herljević, Zoran; Ćorić, Mario; Lešin, Joško; Kuliš, Tomislav; Mareković, Ivana

doi:10.1080/23744235.2022.2131901

Cited by 3 publications

(3 citation statements)

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“…Zrinka Todorić et al reported that 38.0% (165/432) of patients were contaminated to Enterococci spp. in the ICU [42]. The result of a retrospective study also showed an incidence rate 4/10,000 of enterococcus for patients of blood infections [43].…”

Section: Discussionmentioning

confidence: 91%

Disinfectants efficacy in reducing pathogens related to health-care infection associated in universities hospitals of Gorgan, Noth of Iran

Golfiroozi,

Fashayi,

Rajabi

et al. 2024

Preprint

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Background Disinfection have a fundamental role in the control of pathogens in the hospital environment. This study was designed to assess the efficacy and functional impact of disinfectants in reducing pathogens related to healthcare infection associated (HIAs) in hospitals. Methods This observation study was conducted at three university hospitals in Gorgan, Iran, from May to Oct 2023. The data including used disinfectants and microbiological examination were obtained from the infection control unit of each hospital. Results The results showed that a variety of disinfectants from intermediate to high levels were employed in accordance with the World Health Organization (WHO) protocols. The microbial result revealed that 31.6% (286 out of 906) of the sample had at least one microorganism. Among identified organisms, Bacillus spp. were the predominant species followed by Staphylococcus epidermis, fungus genera, Enterobacter spp., Entrococci spp., Pseudomonas spp., Escherichia coli, Alcaligenes spp., Staphylococcus aureus, Citrobacter spp., Corynebacterium spp., Klebsiella spp., Acinetobacter spp., Micrococcus spp., Staphylococcus saprophyticus, and Serratias spp. The highest prevalence rates of microorganisms were observed in the wards of ICU, emergency, internal, and women. The chi-square test revealed a significant relationship between the presence of organism’s and hospital wards (P < 0.05). Conclusion The presence of pathogens indicates a defect in the disinfection process, probably due to both little attention to disinfection protocols and resistance to multidrugs. It is not yet possible to eliminate pathogens from the hospital environment, but it can be minimized by education intervention, standardizing disinfecting processes, and monitoring by the infection control committee.

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Section: Discussionmentioning

confidence: 91%

Disinfectants efficacy in reducing pathogens related to health-care infection associated in universities hospitals of Gorgan, Noth of Iran

Golfiroozi,

Fashayi,

Rajabi

et al. 2024

Preprint

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“…The first report that explored features of vancomycin-resistant Enterococcus strains in Croatia highlighted the propensity of horizontal gene transfer, but also potential resistance transfer to other bacterial pathogens like S. aureus , which may further complicate the resistance landscape ( 27 ). A recent study by Todorić et al ( 28 ) showed an increasing trend in enterococcal bacteremia in Croatia and a significantly higher proportion of vancomycin resistance, with patients in intensive care units being most vulnerable to such infections. Interestingly, our estimates indicate that fluoroquinolone-resistant E. faecium is a more frequent pathogen-drug combination than its vancomycin-resistant counterpart.…”

Section: Discussionmentioning

confidence: 99%

“…The first report that explored features of vancomycin-resistant Enterococcus strains in Croatia highlighted the propensity of horizontal gene transfer, but also potential resistance transfer to other bacterial pathogens like S. aureus, which may further complicate the resistance landscape (27). A recent study by Todorić et al (28) showed an increasing trend in enterococcal bacteremia in Croatia and a significantly higher This is another warning signal about the importance of adequately addressing fluroquinolone prescription habits in Croatia. A recent survey involving 12 urology departments in Croatia showed that fluoroquinolones were by far the most commonly prescribed class of antibiotics (accounting for 84% of prescriptions), and the authors have emphasized how the lack of uniform guidelines contributes to varying protocols, ultimately leading to a concerning escalation in antibiotic resistance (29).…”

Section: Discussionmentioning

confidence: 99%

The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis

Meštrović,

Ikuta,

Swetschinski

et al. 2023

Croat Med J

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Aim To deliver the most wide-ranging set of antimicrobial resistance (AMR) burden estimates for Croatia to date. Methods A complex modeling approach with five broad modeling components was used to estimate the disease burden for 12 main infectious syndromes and one residual group, 23 pathogenic bacteria, and 88 bug–drug combinations. This was represented by two relevant counterfactual scenarios: deaths/disability-adjusted life years (DALYs) that are attributable to AMR considering a situation where drug-resistant infections are substituted with sensitive ones, and deaths/DALYs associated with AMR considering a scenario where people with drug-resistant infections would instead present without any infection. The 95% uncertainty intervals (UI) were based on 1000 posterior draws in each modeling step, reported at the 2.5% and 97.5% of the draws’ distribution, while out-of-sample predictive validation was pursued for all the models. Results The total burden associated with AMR in Croatia was 2546 (95% UI 1558–3803) deaths and 46 958 (28,033–71,628) DALYs, while the attributable burden was 614 (365–943) deaths and 11 321 (6,544–17,809) DALYs. The highest number of deaths was established for bloodstream infections, followed by peritoneal and intra-abdominal infections and infections of the urinary tract. Five leading pathogenic bacterial agents were responsible for 1808 deaths associated with resistance: Escherichia coli , Staphylococcus aureus , Acinetobacter baumannii, Klebsiella pneumoniae , and Pseudomonas aeruginosa (ordered by the number of deaths). Trimethoprim/sulfamethoxazole-resistant E coli and methicillin-resistant S. aureus were dominant pathogen-drug combinations in regard to mortality associated with and attributable to AMR, respectively. Conclusion We showed that AMR represented a substantial public health concern in Croatia, which reflects global trends; hence, our detailed country-level findings may fast-track the implementation of multipronged strategies tailored in accordance with leading pathogens and pathogen-drug combinations.

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Clinical characteristics, predisposing factors and outcomes for Enterococcus faecalis versus Enterococcus faecium bloodstream infections: a prospective multicentre cohort study

Scharloo,

Cogliati Dezza,

López-Hernández

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purposes Enterococcal BSI is associated with significant morbidity and mortality, with fatality rates of approximately 20–30%. There are microbiological and clinical differences between E. faecalis and E. faecium infections. The aim of this study was to investigate differences in predisposing factors for E. faecalis and E. faecium BSI and to explore prognostic factors. Methods This study was a post-hoc analysis of PROBAC, a Spanish prospective, multicenter, cohort in 2016–2017. Patients with E. faecalis or E. faecium BSI were eligible. Independent predictors for BSI development in polymicrobial and monomicrobial BSI and in-hospital mortality in the monomicrobial group were identified by logistic regression. Results A total of 431 patients were included. Independent factors associated with E. faecium BSI were previous use of penicillins (aOR 1.99 (95% CI 1.20–3.32)) or carbapenems (2.35 (1.12–4.93)), hospital-acquired BSI (2.58 (1.61–4.12)), and biliary tract source (3.36 (1.84–6.13)), while congestive heart failure (0.51 (0.27–0.97)), cerebrovascular disease (0.45 (0.21–0.98)), and urinary tract source (0.49 (0.26–0.92)) were associated with E. faecalis BSI. Independent prognostic factors for in-hospital mortality in E. faecalis BSI were Charlson Comorbidity Index (1.27 (1.08–1.51)), SOFA score (1.47 (1.24–1.73)), age (1.06 (1.02–1.10)), and urinary/biliary source (0.29 (0.09–0.90)). For E. faecium BSI, only SOFA score (1.34 (1.14–1.58) was associated with in-hospital mortality. Conclusions The factors associated with E. faecium and E. faecalis BSI are different. These variables may be helpful in the suspicion of one or other species for empiric therapeutic decisions and provide valuable information on prognosis.

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Increasing trend in enterococcal bacteraemia and vancomycin resistance in a tertiary care hospital in Croatia, 2017–2021

Cited by 3 publications

References 28 publications

Disinfectants efficacy in reducing pathogens related to health-care infection associated in universities hospitals of Gorgan, Noth of Iran

Disinfectants efficacy in reducing pathogens related to health-care infection associated in universities hospitals of Gorgan, Noth of Iran

The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis

Clinical characteristics, predisposing factors and outcomes for Enterococcus faecalis versus Enterococcus faecium bloodstream infections: a prospective multicentre cohort study

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